The Indiana PROSPECT builds on the nation's largest, most sophisticated health information exchange that already contains over 2.5 billion structured observations and 38 million text documents for over 10 million patients. This resource is already used for a variety of clinical outcomes and clinical effectiveness research. Based on our analysis of gaps in the infrastructure and experience gained by conducting a specific CER study as part of the PROSPECT, we will enhance this infrastructure to capture richer clinical data and particularly enhance our ability to incorporate patient outcomes, improved capture of device utilization data, capabilities to incorporate genomic and other high throughput results, advanced technologies to identify patient for recruitment and enrollment technologies. In order to demonstrate the usability of this environment and to inform its further development, we propose to conduct a novel CER project evaluating treatment for Alzheimer's. The CER study will evaluate of medication treatment for behavioral symptoms of Alzheimer's disease. Alzheimer's disease has been identified as a first quartile CER priority. Because our approach is population based, we will incorporate a significant minority population. This application represents collaboration between the Medical Informatics Program at the Regenstrief Institute, Inc (a world leader in health information technology) and two Indiana University research programs: the Center for Aging Research and the Division of Clinical Pharmacology. These programs have an established track record in research relevant to under-served populations. Thus, this application combines considerable investigator, environment, and research strengths to continue to build a novel CER infrastructure in support of the nation's evidentiary CER priorities. We will build on our established governance approach to test and improve approaches for sharing access to these research databases and financial models for sustainability based on value created. PUBLIC HEALTH RELEVANCE: Project Narrative This proposal seeks to enhance the existing information technology infrastructure in Central Indiana to improve the nation's capacity to conduct comparative effectiveness research (CER) and apply these new capacities to a novel CER project evaluating treatment for Alzheimer's disease.